The primary goal of the proposed studies is to identify temporal trends in the incidence rate, causes, treatment and outcome of stroke among a large biracial metropolitan population in Cincinnati. There are 1,299,901 people in the greater metropolitan area, 187,806 of whom are black, a percentage that compares favorably with the U.S. population as a whole. The investigators propose to identify every hospitalized or autopsied and almost all non-hospitalized strokes during 1/1/99 through 12/31/99 at all 19 regional hospitals and 147 outpatient screening sites as per the previous five-year funding period. They will identify and abstract detailed information from the medical record for every potential stroke case (methods identical to their ongoing five-year study). In addition, they plan on contacting 500 new ischemic stroke patients (250 blacks-excluding TIAs) and/or their families, to obtain detailed information concerning prior risk factors, knowledge about stroke, outcome following stroke, and buccal cells and/or blood for genetic material. They will replicate a random digit-dialing telephone surgery of 2000 persons from the general population during the year 2000. The estimated 3000 strokes and 700 TIAs as well as the 2000 surveyed persons from the general population will be used to test the following primary hypotheses. 1) The age, sex, and race-adjusted incidence rate of all first-ever stroke, cerebral infarction, and subarachnoid hemorrhage will decrease and the rate of intracerebral hemorrhage will increase during 1999 as compared to incidence rates during 1988 and 1993/4. 2) The 3-month mortality after stroke will be similar for blacks and whites and unchanged from 1993/94, but functional outcome at 3-months as measured by the Barthel Index, Pfeffer Instrumental Activities of Daily Living Scale, and Medical Outcome Study will be poorer among blacks as compared to whites. The investigators state that the long-term goal of this research is to study temporal trends in stroke incidence rates, treatment, and outcome and their relationships to the prevalence of environmental and genetic risk factors for stroke as well as to changes in public knowledge of stroke risk factors and warning signs.
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